PROJECT SUMMARY Dr. Hibbs proposes a patient-oriented research and mentorship program focusing on prematurity-associated pulmonary morbidity. She has a strong track-record for POR research and mentorship and availability of future mentees from junior faculty and trainees at Rainbow Babies and Children's Hospital (RBC) and CWRU; she will integrate mentees in the newly proposed project as well as other currently funded local and multi-center studies. Longer term respiratory morbidity and neurodevelopmental delay are major consequences of preterm birth. In the proposed study, we seek to characterize the association between immature respiratory control, manifesting as intermittent hypoxia (IH), and later respiratory and neurodevelopmental morbidity in a cohort of preterm infants less than or equal to 30 weeks' gestation. This proposal is a two-year follow-up study of the Pre-Vent Case Western Reserve (CWRU) site protocol, and represents a unique opportunity to pair longer-term clinically relevant outcomes, as measured by validated questionnaires, with an already-funded study using sophisticated techniques to capture and analyze early life IH events. Our hypotheses are that IH episodes at one week and one month of life are significantly associated with recurrent wheezing, sleep disordered breathing, and neurodevelopmental delay. In prior studies we have demonstrated that apnea almost always precedes desaturation in preterm infants and have documented a novel association between retinopathy of prematurity, and both the duration of IH events and the time interval between IH events. From these data we speculate that it is not only longer and more frequent IH events, but also distinct time interval of at least one minute between IH events, that will be associated with long-term clinical morbidities. We provide additional retrospective data that IH is associated with wheezing disorders, as well as a remarkable track record for both meeting enrollment goals and effective follow-up in prior clinical studies.